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Yan MY, Liu JM, Wu J, Chang Q. Impact of remote ischemic postconditioning on acute ischemic stroke in China: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2024; 13:141. [PMID: 38816852 PMCID: PMC11138007 DOI: 10.1186/s13643-024-02568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Acute ischemic stroke (AIS) is a significant health burden in China, affecting a sizable portion of the population. Conventional pharmacological treatments frequently fall short of desirable outcomes. Therefore, exploring alternative therapies is crucial. Remote ischemic postconditioning (RIPostC) is a noninvasive and cost-effective adjunctive therapy. This study aimed to investigate the efficacy and safety of RIPostC as an adjunctive therapy for AIS to inform clinical practice. METHODS A comprehensive search was conducted across the PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, Weipu (VIP), and China Biology Medicine disc (CBM) databases up to October 2023. All included studies underwent bias risk assessment using the Cochrane risk-of-bias assessment tool. The primary outcome measure was the National Institute of Health Stroke Scale (NIHSS), with secondary outcomes including the Barthel index (BI), D-dimer, C-reactive protein (CRP), fibrinogen (FIB), brain-derived neurotrophic factor (BDNF), modified Rankin scale (mRS), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels. The data were analyzed using fixed-effects and random-effects models in Review Manager, with mean differences (MDs) and 95% confidence intervals (CIs) calculated for each outcome. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to evaluate the level of evidence for each outcome measure. RESULTS This meta-analysis included 38 studies, encompassing 4334 patients. Compared with the control group, the RIPostC group had significantly lower NIHSS scores, serum CRP, D-dimer, IL-6, TNF-α, and FIB levels, and increased BDNF levels. Moreover, it improved the patient's BI and mRS scores. According to the GRADE approach, the quality of evidence for mRS was deemed "moderate," while the NIHSS, BI, and CRP were rated as "low" quality. IL-6, TNF-α, FIB, D-dimer, and BDNF received "very low" quality ratings. CONCLUSION The findings suggest that RIPostC activates endogenous protective mechanisms, providing benefits to patients with AIS.
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Affiliation(s)
- Ming-Yuan Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Min Liu
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Jing Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qing Chang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China.
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Yan M, Wu J, Wang L, Wang K, Li L, Sun T, Zhang H, Zhang M, Zou L, Yang S, Liu J. Ginkgolide injections in meglumine, combined with edaravone, significantly increases the efficacy in acute ischemic stroke: A meta-analysis. Front Pharmacol 2024; 14:1236684. [PMID: 38726464 PMCID: PMC11079130 DOI: 10.3389/fphar.2023.1236684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/04/2023] [Indexed: 05/12/2024] Open
Abstract
Objective This study aimed to evaluate the efficacy of combining diterpene ginkgolide meglumine injection (DGMI) with edaravone for the treatment of acute ischemic stroke. This is particularly relevant because Western drugs, excluding intravenous thrombolysis, have shown limited success. Methods A comprehensive search was conducted using multiple databases, including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure WanFang, VIP, and Chinese Biomedical Database (CBM) until June 2023. The data were analyzed using fixed-effects and random-effects models in Review Manager. The mean difference with 95% confidence interval was calculated for each outcome. Results Eighteen studies involving 1,636 participants were included in the analysis. The DGMI group showed significant reductions in the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, and C-reactive protein (CRP) level, compared to the control group. Furthermore, the DGMI group showed a significant improvement in superoxide dismutase (SOD) levels and a reduction in malondialdehyde (MDA) levels. The combination of DGMI and edaravone was more effective in reducing neuron-specific enolase (NSE) levels following brain tissue injury than edaravone alone. Additionally, DGMI complemented edaravone in reducing rheological parameters associated with ischemic stroke, including hematocrit, plasma viscosity, platelet adhesion rate, and erythrocyte deformation index. Conclusion The combination of DGMI and edaravone significantly improved the therapeutic efficacy in patients with acute ischemic stroke. However, more extensive and high-quality clinical trials are required to validate these underlying mechanisms. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=260215, identifier: PROSPERO (CRD42021260215).
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Affiliation(s)
- Mingyuan Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wu
- Dongzhimen Hospital, University of Chinese Medicine, Beijing, China
| | - Le Wang
- Encephalopathy Department I, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kaiyue Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Lili Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Tianye Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Han Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Mi Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Lin Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Songyi Yang
- Beijing University of Chinese Medicine, Beijing, China
| | - Jinmin Liu
- Encephalopathy Department I, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Choi ES, Jung YM, Kim D, Cho SE, Park ES, Park CW, Park JS, Jun JK, Lee SM. Long-term cardiovascular outcome in women with preeclampsia in Korea: a large population-based cohort study and meta-analysis. Sci Rep 2024; 14:7480. [PMID: 38553468 PMCID: PMC10980767 DOI: 10.1038/s41598-024-57858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Recent studies reported the long-term cardiovascular risk of preeclampsia. However, only a few studies have investigated the association between preeclampsia and long-term cardiovascular disease in Asian populations, although there could be racial/ethnic differences in the risk of cardiovascular diseases. Therefore, we aimed to evaluate the long-term effects of preeclampsia on cardiovascular disease in an Asian population. This study included 68,658 parous women in the Health Examinees Study (HEXA) cohort of South Korea and compared the risk of long-term cardiovascular disease, including ischemic heart disease and stroke, according to the history of preeclampsia. We also performed a meta-analysis combining current study data with data from existing literature in the Asian population. Among the study population, 3413 (5.23%) women had a history of preeclampsia, and 767 (1.12%) and 404 (0.59%) women developed ischemic heart disease and stroke for 22 years. Women with a history of preeclampsia were at a higher risk for both ischemic heart disease (adjusted hazard ratio 1.66 [1.19-2.04]) and stroke (adjusted hazard ratio 1.48 [1.02-2.16]) than those without. In the meta-analysis, the pooled hazard ratio of ischemic heart disease and stroke were also increased in women with a history of preeclampsia (ischemic heart disease 1.65 [1.51-1.82]; stroke 1.78 [1.52-2.10]).
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, College of Medicine, Guro Hospital, Korea University, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Dayoung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Su Eun Cho
- Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Eun Sun Park
- Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Nanavati HD, Andrabi M, Arevalo YA, Liu E, Shen J, Lin C. Disparities in Race and Ethnicity Reporting and Representation for Clinical Trials in Stroke: 2010 to 2020. J Am Heart Assoc 2024; 13:e033467. [PMID: 38456461 PMCID: PMC11010007 DOI: 10.1161/jaha.123.033467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Racial and ethnic minority groups are at a higher stroke risk and have poor poststroke outcomes. The aim of this study was to assess the frequency of race reporting and proportions of race and ethnicity representation in stroke-related clinical trials. METHODS AND RESULTS This is a descriptive study of stroke-related clinical trials completed between January 1, 2010 and December 31, 2020, and registered on ClinicalTrials.gov. Trials conducted in the United States, related to stroke and enrolling participants ≥18 years, were considered eligible. Trials were reviewed for availability of published results, data on race and ethnicity distribution, and trial characteristics. Overall, 60.1% of published trials reported race or ethnicity of participants, with a 2.6-fold increase in reporting between 2010 and 2020. White patients represented 65.0% of the participants, followed by 24.8% Black, 2.4% Asian or Pacific Islander, and <1% Native American and multiracial participants; 9.0% were of Hispanic ethnicity. These trends remained consistent throughout the study period, except in 2018, when a higher proportion of Black participants (53.1%) was enrolled compared with White participants (35.8%). Trials with the National Institutes of Health/federal funding had higher enrollment of Black (28.1%) and Hispanic (13.8%) participants compared with other funding sources. Behavioral intervention trials had the most diverse enrollment with equal enrollment of Black and White participants (41.1%) and 14.5% Hispanic participants. CONCLUSIONS Despite the increase in race and ethnicity reporting between 2010 and 2020, the representation of racial and ethnic minority groups remains low in stroke trials. Funding initiatives may influence diversity efforts in trial enrollment.
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Affiliation(s)
- Hely D. Nanavati
- Department of EpidemiologyThe University of Alabama at BirminghamBirminghamAL
| | - Mudasir Andrabi
- Capstone College of NursingThe University of AlabamaTuscaloosaAL
| | - Yurany A. Arevalo
- Department of NeurologyThe University of Alabama at BirminghamBirminghamAL
| | - Evan Liu
- Heersink School of MedicineThe University of Alabama at BirminghamBirminghamAL
| | - Jeffrey Shen
- Department of RheumatologyDuke UniversityDurhamNC
| | - Chen Lin
- Department of NeurologyThe University of Alabama at BirminghamBirminghamAL
- Birmingham VA Medical CenterBirminghamAL
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Nogueira RG, Kimura K, Matsumaru Y, Suzuki K, Qiu Z, Zi W, Moran TP, Li F, Sang H, Luo W, Liu S, Yuan J, Song J, Huang J, Takeuchi M, Morimoto M, Otsuka T, Yang Q. Systemic THrombolysis Randomization IN Endovascular Stroke Therapy (SHRINE) Collaboration: a patient-level pooled analysis of the SKIP and DEVT Trials. J Neurointerv Surg 2024; 16:359-364. [PMID: 37290918 DOI: 10.1136/jnis-2023-020307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the non-inferiority of endovascular treatment (EVT) alone versus intravenous thrombolysis (IVT) followed by EVT and to assess its heterogeneity across prespecified subgroups. METHODS We pooled data from two trials (SKIP in Japan; DEVT in China). Individual patient data were pooled to assess outcomes and heterogeneity of treatment effect. The primary outcome was functional independence (modified Rankin Scale score 0-2) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. RESULTS We included 438 patients (217 EVT alone; 221 combined IVT+EVT). The meta-analysis failed to demonstrate the non-inferiority of EVT alone over combined IVT+EVT in achieving 90-day functional independence (56.7% vs 51.6%; adjusted common odds ratio (cOR)=1.27, 95% CI 0.84 to 1.92, pnon-inferiority=0.06). Effect sizes favoring EVT alone were present with stroke onset to puncture time longer than 180 min (cOR=2.28, 95% CI 1.18 to 4.38, pinteraction ≤180 vs >180 min=0.02) and intracranial internal carotid artery ICA occlusions (for ICA cOR=3.04, 95% CI 1.10 to 8.43, pinteraction ICA vs MCA=0.08). The rates of sICH (6.5% vs 9.0%; cOR=0.77, 95% CI 0.37 to 1.61) and 90-day mortality (12.9% vs 13.6%; cOR=1.05, 95% CI 0.58 to 1.89) were comparable. CONCLUSIONS The cumulative data of these two recent Asian trials failed to unequivocally demonstrate the non-inferiority of EVT alone over combined IVT+EVT. However, our study suggests a potential role for more individualized decision-making. Specifically, Asian patients with stroke onset to EVT longer than 180 min, as well as those with intracranial ICA occlusions and those with atrial fibrillation might have better outcomes with EVT alone than with combined IVT+EVT.
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Affiliation(s)
- Raul G Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology, 903th Hospital of PLA, Hangzhou, Zhejiang, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Timothy P Moran
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongfei Sang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weidong Luo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Junjie Yuan
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | | | - Masafumi Morimoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Yokohama, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-ku, Japan
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Antonio AA, Anderson T, Ngo V, Park S, Woolner S, Farooq M, Santos R, Gorelick P. Diversity, Equity, and Inclusion Lessons From Developing Stroke Education Programs for West Michigan Asian Communities. Stroke 2024; 55:757-761. [PMID: 38299388 DOI: 10.1161/strokeaha.123.043092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Asians in the United States, facing health care disparities, have increased stroke risk. Multiple subgroups, with distinct cultures and languages, add complexity to caring for Asian American (AsA) communities. We developed a tailored stroke education program for underserved West Michigan AsA communities. Methodology, lessons learned, and diversity, equity, and inclusion insights are described. METHODS Neurology residents and faculty, in collaboration with trained community-specific navigators, developed culturally resonant stroke education that was tailored to meet the needs of specific self-identified West Michigan AsA communities. Educational and debriefing sessions were delivered over 6 months, following the Plan-Do-Study-Act model, to elucidate diversity, equity, and inclusion insights and improve materials and delivery methods. RESULTS Eighty-six non-English-speaking participants from 5 self-identified AsA communities (Burmese, Buddhist Vietnamese, Catholic Vietnamese, Chinese, and Nepali) attended educational stroke sessions. The average age of attendees was 57.6±13.2 years; most were females (70%). Diversity, equity, and inclusion insights included identification of Asian cultural beliefs about acute stroke treatment (eg, bloodletting), investigator insights (eg, need for kitchen-table programs), systemic barriers (eg, language), and mitigation strategies. CONCLUSIONS Institutions should consider the integration of equity-focused, trainee-influenced quality improvement projects, such as this culturally resonant stroke educational program for AsA, to enhance stroke care in these vulnerable communities.
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Affiliation(s)
- Aileen A Antonio
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Taylor Anderson
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Vincent Ngo
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Sojung Park
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Susan Woolner
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Muhammad Farooq
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Ronel Santos
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Philip Gorelick
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
- Davee Department of Neurology, Northwestern University, Chicago, IL (P.G.)
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Lv W, Ruan Z, Zhang Q, Wei Y, Wu X, Dou YN, Chao W, Fei X, Fei Z. Serum Homer1 is a Novel Biomarker for Predicting the Clinical Outcomes of Acute Ischemic Stroke Patients. J Inflamm Res 2024; 17:1337-1347. [PMID: 38434583 PMCID: PMC10908339 DOI: 10.2147/jir.s453018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose We aim to explore the relationship between Homer1 and the outcomes of AIS patients at 3 months. Patients and Methods This prospective cohort study was conducted from May 2022 to March 2023. In this study, we investigated the association between serum Homer1 levels by enzyme-linked immunosorbent assay at admission and functional outcomes of patients at 3 months after AIS. Results Overall, 89 AIS patients (48 good outcomes and 41 poor outcomes) and 83 healthy controls were included. The median serum Homer1 level of patients at admission with poor outcomes was significantly higher than that of patients with good outcomes (39.33 vs 33.15, P<0.001). Serum Homer1 levels at admission were positively correlated with the severity of AIS (r = 0.488, P<0.001). The optimal cutoff of serum Homer1 level as an indicator for an auxiliary diagnosis of 3 months functional outcomes was 35.07 pg/mL, with a sensitivity of 75.0% and a specificity of 92.7% (AUC 0.837; 95% CI [0.744-0.907]; P<0 0.001). The odds ratio of MRS > 2 predicted by the level of serum Homer1 after 3 months was 1.665 (1.306-2.122; P<0.001). Conclusion Serum concentrations of Homer1 have a high predictive value for neurobehavioral outcomes after acute ischemic stroke. Higher serum Homer1 levels (>35.07 pg/mL) were positively associated with poor functional outcomes of patients 3 months post-stroke.
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Affiliation(s)
- Weihao Lv
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Qianqian Zhang
- Department of Respiratory Medicine, Lanzhou University Second Hospital, Lanzhou, 730070, People’s Republic of China
| | - Yaxuan Wei
- Department of Neurology, Gansu Province Central Hospital, Lanzhou, 730070, People’s Republic of China
| | - Xiuquan Wu
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Ya-Nan Dou
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Wangshu Chao
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Xiaowei Fei
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
| | - Zhou Fei
- Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Hussein HM, Yang MK, Ramezani S, Sharma R, Lodhi OUH, Owens-Pochinka Y, Lu J, Elbokl A. Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals. J Clin Med 2023; 12:7654. [PMID: 38137723 PMCID: PMC10743521 DOI: 10.3390/jcm12247654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION This analysis was conducted as a part of a quality improvement project aiming at identifying racial disparity in inpatient stroke quality of care. METHODS The Get With The Guidelines (GWTG) database was used to identify all patients discharged with any stroke diagnosis between January and December 2021. An additional chart review was conducted to ensure the accuracy of racial/ethnic categorization. The sample was dichotomized into white vs. non-white groups and compared with univariate analysis. RESULTS The study sample comprised 1408 encounters (1347 patients) with Mean age of 71 ± 15 years, 51% women, 82% white patients, 15% non-white patients, 72% acute ischemic stroke (AIS); 15% transient ischemic attack (TIA), 9% intracerebral hemorrhage (ICH), 3% subarachnoid hemorrhage (SAH), and 1% stroke not otherwise specified. Non-white patients were younger and had fewer concomitant diagnoses, a lower proportion of TIA, and a higher proportion of ICH (p = 0.004). In the AIS cohort, compared to white patients, non-white patients had less frequent ambulance (p = 0.009), arrived at the hospital later than white patients (7.7 h longer; p < 0.001), had more severe strokes, and had less frequent IV thrombolysis utilization (7% vs. 13%; p = 0.042). Similarly, in the TIA cohort, non-white patients' utilization of EMS was lower than that of white patients, and their hospital arrival was delayed. In the ICH cohort, non-white patients were younger and had a lower frequency of atrial fibrillation and a non-significant trend toward higher disease severity. The SAH cohort had only eight non-white patients, six of whom were transferred to a higher level of hospital care within a few hours of arrival. Importantly, the hospital-based quality metrics, such as door-to-CT time, door-to-needle time, and the Joint Commission stroke quality metrics, were similar between the two groups. CONCLUSIONS There is a racial disparity in the pre-hospital phase of the stroke chain of survival of non-white patients, impacting IV thrombolysis utilization. The younger age and worse lipid profile and hemoglobin A1c of non-white patients suggest the need for better preventative care starting at a young age.
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Affiliation(s)
- Haitham M. Hussein
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Mai-Kau Yang
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Solmaz Ramezani
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Rishi Sharma
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Omair ul haq Lodhi
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Yaroslav Owens-Pochinka
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Jinci Lu
- Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455, USA (S.R.); (R.S.); (O.u.h.L.); (Y.O.-P.); (J.L.)
| | - Ahmed Elbokl
- Institute of Health Informatics, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Neurology, Ain Shams University, Cairo 11517, Egypt
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10
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Brown GG, Foroughi R, Bandela S, Cardentey A, Clark KL, Dula AN. A tale of two cities: A retrospective observational cohort study of the impact of COVID-19 on acute stroke presentation, timing, and outcomes. J Stroke Cerebrovasc Dis 2023; 32:107274. [PMID: 37506542 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES The purpose of this study was to identify the impact of COVID-19-related "shelter in place" restrictions on stroke metrics in two metropolitan Texas cities, Austin and San Antonio. MATERIALS AND METHODS Data was derived from stroke quality metric registries and compared between two treatment periods: (1) during the state's COVID-19 "shelter in place" restriction period, and (2) the corresponding period during the previous year for Austin and San Antonio, Texas. Primary outcomes include the dichotomized process measures of time last known well (TLKW) to arrival, arrival to brain imaging initiation, and arrival to administration of thrombolytic therapy. Secondary outcomes are clinical endpoints: independent ambulation at discharge, discharge to home, and in-hospital mortality. RESULTS Austin patients were older and presented with less-severe strokes. San Antonio patients were more likely to be Hispanic, suffer from a large vessel occlusion, and have independent ambulation at discharge (adjusted odds ratio, 2.04; 95% confidence intervals, (1.25-3.37). Within-city analyses revealed a trend toward increased TLKW to arrival in Austin and San Antonio during COVID-19. During COVID, Austin patients had decreased length of stay (LOS) while a higher proportion of San Antonio patients had a favorable outcome (discharged home & independent ambulation). CONCLUSIONS Longer TLKW to hospital arrival during COVID did not impact arrival-to-imaging, arrival-to-treatment times nor patient outcomes, even in patients at higher risk for stroke. Future studies should continue to assess the impact of COVID-19 on stroke care and outcomes pre- and post-introduction of the COVID-19 vaccine, and as infectivity rates spike or recede.
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Affiliation(s)
| | - Razieh Foroughi
- Departments of Neurology and Diagnostic Medicine, Dell Medical School at University of Texas at Austin, USA; Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sujani Bandela
- Departments of Neurology and Neurosurgery, The University of Texas Health Science Center at San Antonio, USA
| | - Agnelio Cardentey
- Departments of Neurology and Neurosurgery, The University of Texas Health Science Center at San Antonio, USA
| | - Kal L Clark
- Department of Radiology, The University of Texas Health Science Center at San Antonio, USA
| | - Adrienne N Dula
- Departments of Neurology and Diagnostic Medicine, Dell Medical School at University of Texas at Austin, USA.
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11
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Findlay MC, Bauer SZ, Khan M, Kim RB, Park S, Alexander H, Karsy M. Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study. Neurosurgery 2023; 93:176-185. [PMID: 36762909 DOI: 10.1227/neu.0000000000002397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/07/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Race-based health care outcomes remain to be described in anterior cranial fossa (ACF) surgery. OBJECTIVE To determine whether race predicts worse outcomes after ACF surgery. METHODS A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program data for 2005 to 2020. Current Procedural Terminology and International Classification of Diseases-9 codes were used to identify ACF tumor cases. Propensity score matching was performed to compare White and minority patients to assess the robustness of unmatched findings. A subanalysis of pituitary adenoma (PA) resections was also performed. RESULTS In an unmatched analysis of 1370 patients who underwent ACF surgery (67.9% White, 17.4% Black, 6.6% Asian/Pacific Islander, and 6.3% Hispanic), minority groups had higher rates of comorbidities. Unmatched multivariate analysis found Hispanic patients bore a 1.86 odds ratio (OR) of minor complications, Black and Asian and Pacific Islander patients bore 1.49 and 1.71 ORs, respectively, for extended length of stay, and Black patients bore a 3.78 OR for urinary tract infection (UTI). Matched analysis found that minority patients had higher UTI rates ( P = .02) and a 4.11 OR of UTI. In PA cases specifically, minority groups had higher comorbidities and length of stay in addition to extended length of stay odds (1.84 OR). CONCLUSION Although most ACF surgery outcomes were unaffected by race, minority groups had more minor postoperative complications than White patients, particularly UTI. Similar disparities were observed among PA cases. Higher rates of comorbidities may also have led to longer hospital stays. Further study is needed to understand what actions might be necessary to address any race-associated health disparities in ACF surgery.
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Affiliation(s)
| | - Sawyer Z Bauer
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Majid Khan
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Robert B Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Seojin Park
- New York University, New York, New York, USA
| | - Hepzibha Alexander
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Michael Karsy
- School of Medicine, University of Nevada, Reno, Nevada, USA
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12
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Faigle R. Racial and Ethnic Disparities in Stroke Reperfusion Therapy in the USA. Neurotherapeutics 2023; 20:624-632. [PMID: 37219714 PMCID: PMC10275817 DOI: 10.1007/s13311-023-01388-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
Racial and ethnic inequities in stroke care are ubiquitous. Acute reperfusion therapies, i.e., IV thrombolysis (IVT) and mechanical thrombectomy (MT), are central to acute stroke care and are highly efficacious at preventing death and disability after stroke. Disparities in the use of IVT and MT in the USA are pervasive and contribute to worse outcomes among racial and ethnic minority individuals with ischemic stroke. A meticulous understanding of disparities and underlying root causes is necessary in order to develop targeted mitigation strategies with lasting effects. This review details racial and ethnic disparities in the use of IVT and MT after stroke and highlights inequities in the underlying process measures as well as the contributing root causes. Furthermore, this review spotlights the systemic and structural inequities that contribute to race-based differences in the use of IVT and MT, including geographic and regional differences and differences based on neighborhood, zip code, and hospital type. In addition, recent promising trends suggesting improvements in racial and ethnic IVT and MT disparities and potential approaches for future solutions to achieve equity in stroke care are briefly discussed.
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Affiliation(s)
- Roland Faigle
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 484, Baltimore, MD, 21287, USA.
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13
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Calvert P, Tamirisa K, Al-Ahmad A, Lip GYH, Gupta D. Racial and Ethnic Disparities in Stroke Prevention for Atrial Fibrillation. Am J Med 2023; 136:225-233. [PMID: 36495932 DOI: 10.1016/j.amjmed.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 12/13/2022]
Abstract
Racial and ethnic disparities in health care are well documented, although often underappreciated. In the setting of atrial fibrillation, stroke risk and severity may be higher in underrepresented ethnic populations. Additionally, the risk of bleeding is not uniform, and pharmacogenetics play an important role in anticoagulant therapy. In this narrative review, we discuss the complex issues surrounding stroke prevention in underrepresented ethnic groups with atrial fibrillation.
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Affiliation(s)
- Peter Calvert
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom
| | | | | | - Gregory Y H Lip
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom
| | - Dhiraj Gupta
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, United Kingdom.
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14
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1084] [Impact Index Per Article: 1084.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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15
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Ngo VTH, Park SK, Anderson T, Antonio A. To the Editor: Hitting the Mark on a Real Issue. J Grad Med Educ 2022; 14:729-730. [PMID: 36591426 PMCID: PMC9765916 DOI: 10.4300/jgme-d-22-00747.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Vincent Trung Huu Ngo
- PGY-3 Resident, Trinity Health Saint Mary's Neurology Residency Program, Hauenstein Neurosciences
| | - Sojung Kara Park
- PGY-3 Resident, Trinity Health Saint Mary's Neurology Residency Program, Hauenstein Neurosciences
| | - Taylor Anderson
- PGY-4 Resident, Trinity Health Saint Mary's Neurology Residency Program, Hauenstein Neurosciences
| | - Aileen Antonio
- Assistant Program Director for Curriculum, Trinity Health Saint Mary's Neurology Residency Program, Hauenstein Neurosciences
- Neuro-Ophthalmologist, Hauenstein Neurosciences
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16
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Liu R, Zhao J, Li X, Messe S, Fisher M, Rudd A. To use stroke 911 to improve stroke awareness for countries where 911 is used as an emergency phone number. CNS Neurosci Ther 2022; 28:1473-1475. [PMID: 35924380 PMCID: PMC9437232 DOI: 10.1111/cns.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hosptial, Fudan University, Shanghai, China
| | - Xiaobin Li
- Internal Medicine and President, Everest Medical Group, Philadelphi, Pennsylvania, USA
| | - Steven Messe
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Rudd
- Stroke Medicine, Kings College London, London, UK
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17
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Liu Y, Wang W, Huang X, Zhang X, Lin L, Qin J, Lei F, Cai J, Cheng B. Global disease burden of stroke attributable to high fasting plasma glucose in 204 countries and territories from 1990 to 2019: An analysis of the Global Burden of Disease Study. J Diabetes 2022; 14:495-513. [PMID: 35924673 PMCID: PMC9426282 DOI: 10.1111/1753-0407.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND High fasting plasma glucose (HFPG) is the leading risk factor contributing to the increase of stroke burden in the past three decades. However, the global distribution of stroke burden specifically attributable to HFPG was not studied in depth. Therefore, we analyzed the HFPG-attributable burden in stroke and its subtypes in 204 countries and territories from 1990 to 2019. METHODS Detailed data on stroke burden attributable to HFPG were obtained from the Global Burden of Disease Study 2019. The numbers and age-standardized rates of stroke disability-adjusted life years (DALYs), deaths, years lived with disability, and years of life lost between 1990 and 2019 were estimated by age, sex, and region. RESULTS In 2019, the age-standardized rate of DALYs (ASDR) of HFPG-attributable stroke was 354.95 per 100 000 population, among which 49.0% was from ischemic stroke, 44.3% from intracerebral hemorrhage, and 6.6% from subarachnoid hemorrhage. The ASDRs of HFPG-attributable stroke in lower sociodemographic index (SDI) regions surpassed those in higher SDI regions in the past three decades. Generally, the population aged over 50 years old accounted for 92% of stroke DALYs attributable to HFPG, and males are more susceptible to HFPG-attributable stroke than females across their lifetime. CONCLUSIONS Successful key population initiatives targeting HFPG may mitigate the stroke disease burden. Given the soaring population-attributable fractions of HFPG for stroke burden worldwide, each country should assess its disease burden and determine targeted prevention and control strategies.
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Affiliation(s)
- Yang Liu
- Department of StomatologyZhongnan Hospital of Wuhan UniversityWuhanChina
- Institute of Model Animal, Wuhan UniversityWuhanChina
| | - Wenxin Wang
- Institute of Model Animal, Wuhan UniversityWuhanChina
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Xuewei Huang
- Institute of Model Animal, Wuhan UniversityWuhanChina
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan UniversityWuhanChina
- School of Basic Medical ScienceWuhan UniversityWuhanChina
| | - Lijin Lin
- Institute of Model Animal, Wuhan UniversityWuhanChina
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Juan‐Juan Qin
- Institute of Model Animal, Wuhan UniversityWuhanChina
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Fang Lei
- Institute of Model Animal, Wuhan UniversityWuhanChina
- School of Basic Medical ScienceWuhan UniversityWuhanChina
| | - Jingjing Cai
- Department of CardiologyThe Third Xiangya Hospital, Central South University, ChangshaChangshaChina
| | - Bo Cheng
- Department of StomatologyZhongnan Hospital of Wuhan UniversityWuhanChina
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18
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Kanaya AM, Hsing AW, Panapasa SV, Kandula NR, Araneta MRG, Shimbo D, Wang P, Gomez SL, Lee J, Narayan KMV, Mau MKLM, Bose S, Daviglus ML, Hu FB, Islam N, Jackson CL, Kataoka-Yahiro M, Kauwe JSK, Liu S, Ma GX, Nguyen T, Palaniappan L, Setiawan VW, Trinh-Shevrin C, Tsoh JY, Vaidya D, Vickrey B, Wang TJ, Wong ND, Coady S, Hong Y. Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Ann Intern Med 2022; 175:574-589. [PMID: 34978851 PMCID: PMC9018596 DOI: 10.7326/m21-3729] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.
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Affiliation(s)
- Alka M Kanaya
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Ann W Hsing
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | | | | | | | - Daichi Shimbo
- Columbia University Irving Medical Center, New York, New York (D.S.)
| | - Paul Wang
- Stanford University, Stanford, California (A.W.H., P.W., L.P.)
| | - Scarlett L Gomez
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | - Jinkook Lee
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | | | | | - Sonali Bose
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | | | - Frank B Hu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (F.B.H.)
| | - Nadia Islam
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Chandra L Jackson
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland (C.L.J.)
| | | | | | - Simin Liu
- Brown University, Providence, Rhode Island (S.L.)
| | - Grace X Ma
- Temple University, Philadelphia, Pennsylvania (G.X.M.)
| | - Tung Nguyen
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - V Wendy Setiawan
- University of Southern California, Los Angeles, California (J.L., V.W.S.)
| | - Chau Trinh-Shevrin
- New York University Grossman School of Medicine, New York, New York (N.I., C.T.)
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California (A.M.K., S.L.G., T.N., J.Y.T.)
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, New York, New York (S.B., B.V.)
| | - Thomas J Wang
- University of Texas Southwestern Medical Center, Dallas, Texas (T.J.W.)
| | - Nathan D Wong
- University of California, Irvine, Irvine, California (N.D.W.)
| | - Sean Coady
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
| | - Yuling Hong
- National Heart, Lung, and Blood Institute, Bethesda, Maryland (S.C., Y.H.)
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19
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Feng JH, Hu XL, Lv XY, Hong Y, Zhang YH, Long H, Wang R, Wang JJ, Xiong F, Wang H. 4-Trifluoromethyl-(E)-cinnamoyl]-L-4-F-phenylalanine acid exerts its effects on the prevention, post-therapeutic and prolongation of the thrombolytic window in ischemia-reperfusion rats through multiple mechanisms of action. Pharmacol Res 2022; 178:106182. [PMID: 35304259 DOI: 10.1016/j.phrs.2022.106182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 01/14/2023]
Abstract
Ischemic stroke is one of the leading causes of death and disability worldwide. The severe sequelae caused by ischemic thrombolysis and the narrow time window are now the main clinical challenges. Our previous study has reported 4-Trifluoromethyl-(E)-cinnamoyl]-L-4-F-phenylalanine Acid (AE-18) was a promising candidate for Parkinson's Disease. In this study, the preventive and therapeutic effects of AE-18 on focal cerebral ischemia-reperfusion injury and the mechanisms are explored. In oxygen glucose deprivation/reoxygenation (OGD/R)-induced well-differentiated PC12 cells model, AE-18 (10 or 20 μM) can significantly reduce nerve damage when administered before or after molding. In middle cerebral artery occlusion-reperfusion (MCAO/R) rat model, pre-modelling, or post-modelling administration of AE-18 (5 or 10 mg/kg) was effective in reducing neurological damage, decreasing infarct volume and improving motor disturbances. In addition, AE-18 (5 mg/kg) given by intravenous injection immediately after occlusion significantly reduce the infarct volume caused by reperfusion for different durations, indicating that AE-18 could extend the time window of thrombolytic therapy. Further studies demonstrate that AE-18 exerts the effects in the prevention, treatment, and prolongation of the time window of cerebral ischemic injury mainly through inhibiting excitotoxicity and improving BBB permeability, VEGF and BDNF. These results suggest that AE-18 is a good candidate for the treatment of ischemic stroke.
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Affiliation(s)
- Jia-Hao Feng
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Xiao-Long Hu
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Xian-Yu Lv
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Yu Hong
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Yuan-Hao Zhang
- Department of Biological sciences, Xi'an Jiaotong-Liverpool University, Suzhou 215123, People's Republic of China
| | - Huan Long
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Rong Wang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Jing-Jin Wang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Fei Xiong
- State Key Laboratory of Bioelectronics, Jiangsu Laboratory for Biomaterials and Devices, Southeast University, Nanjing 210009, People's Republic of China.
| | - Hao Wang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China.
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20
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Meng T, Trickey AW, Harris AHS, Matheson L, Rosenthal S, Traboulsi AAR, Saver JL, Wagner T, Govindarajan P. Lessons Learned From the Historical Trends on Thrombolysis Use for Acute Ischemic Stroke Among Medicare Beneficiaries in the United States. Front Neurol 2022; 13:827965. [PMID: 35309566 PMCID: PMC8931506 DOI: 10.3389/fneur.2022.827965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe most recent time trends on intravenous thrombolysis (IVT) utilization for acute ischemic stroke was reported in 2011 using the Get with the Guidelines. Our objectives are to assess and validate the change in IVT utilization through 2014 in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization.MethodsWe built a comprehensive national stroke registry by combining patient-level, stroke center status, and geographical characteristics, using multiple data sources. Using multiple national administrative databases from 2007 to 2014, we generated a mixed-effect logistic regression model to characterize the independent associations of patient, hospital, and geographical characteristics with IVT in 2014.ResultsUse of IVT increased consistently from 2.8% in 2007 to 7.7% in 2014, P < 0.001. Between group differences persisted, with lower odds of use in patients who were ≥86 years (aOR 0.74, 95% CI 0.65–0.83), Black (aOR 0.73, 95% CI 0.61–0.87), or treated at a rural hospital (aOR 0.88, 95% CI 0.77–1.00). Higher odds of use were observed in patients who arrived by ambulance (aOR 2.67, 95% CI 2.38–3.00), were treated at a hospital certified as a stroke center (aOR 1.96, 95% CI 1.68–2.29), or were treated at hospitals located in the most socioeconomically advantaged areas (aOR 1.27, 95% CI 1.05–1.54).ConclusionsBetween 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics. These findings can inform ongoing efforts to optimize the delivery of IVT to all AIS patients nationwide.
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Affiliation(s)
- Tong Meng
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
| | - Alex H. S. Harris
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, United States
| | - Loretta Matheson
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
| | - Sarah Rosenthal
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
| | | | - Jeffrey L. Saver
- Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Todd Wagner
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, United States
| | - Prasanthi Govindarajan
- Department of Emergency Medicine, Stanford University, Stanford, CA, United States
- Stanford–Surgery Policy Improvement Research & Education Center (S-SPIRE), Department of Surgery, Stanford, CA, United States
- *Correspondence: Prasanthi Govindarajan
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21
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2303] [Impact Index Per Article: 1151.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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22
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Schneider EC, Chin MH, Graham GN, Lopez L, Obuobi S, Sequist TD, McGlynn EA. Increasing Equity While Improving the Quality of Care: JACC Focus Seminar 9/9. J Am Coll Cardiol 2021; 78:2599-2611. [PMID: 34887146 PMCID: PMC9172264 DOI: 10.1016/j.jacc.2021.06.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 01/14/2023]
Abstract
This review summarizes racial and ethnic disparities in the quality of cardiovascular care-a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work-the driver diagram-to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes.
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Affiliation(s)
| | - Marshall H Chin
- University of Chicago, Section of General Internal Medicine, Chicago, Illinois, USA
| | - Garth N Graham
- Healthcare and Public Health, Google, Palo Alto, California, USA
| | - Lenny Lopez
- Division of Hospital Medicine, San Francisco VA Medical Center, University of California-San Francisco, Department of Medicine, San Francisco, California, USA
| | - Shirlene Obuobi
- Internal Medicine, University of Chicago, Section of Cardiology, Chicago, Illinois, USA
| | - Thomas D Sequist
- Division of General Medicine, Brigham and Women's Hospital, Department of Health Care Policy, Harvard Medical School, Department of Quality and Patient Experience, Mass General Brigham, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
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23
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Mital R, Bayne J, Rodriguez F, Ovbiagele B, Bhatt DL, Albert MA. Race and Ethnicity Considerations in Patients With Coronary Artery Disease and Stroke: JACC Focus Seminar 3/9. J Am Coll Cardiol 2021; 78:2483-2492. [PMID: 34886970 DOI: 10.1016/j.jacc.2021.05.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 01/29/2023]
Abstract
Notable racial and ethnic differences and disparities exist in coronary artery disease (CAD) and stroke epidemiology and outcomes despite substantial advances in these fields. Racial and ethnic minority subgroups remain underrepresented in population data and clinical trials contributing to incomplete understanding of these disparities. Differences in traditional cardiovascular risk factors such as hypertension and diabetes play a role; however, disparities in care provision and process, social determinants of health including socioeconomic position, neighborhood environment, sociocultural factors, and racial discrimination within and outside of the health care system also drive racial and ethnic CAD and stroke disparities. Improved culturally congruent and competent communication about risk factors and symptoms is also needed. Opportunities to achieve improved and equitable outcomes in CAD and stroke must be identified and pursued.
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Affiliation(s)
- Rohit Mital
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Joseph Bayne
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, California, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco, San Francisco, California, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle A Albert
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
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24
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Abstract
Neurologic health disparities are created and perpetuated by structural and social determinants of health. These factors include, but are not limited to, interpersonal bias, institutional factors that lead to disparate access to care, and neighborhood-level factors, such as socioeconomic status, segregation, and access to healthy food. Effects of these determinants of health can be seen throughout neurology, including in stroke, epilepsy, headache, amyotrophic lateral sclerosis, multiple sclerosis, and dementia. Interventions to improve neurologic health equity require multilayered approaches to address these interdependent factors that create and perpetuate disparate neurologic health access and outcomes.
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Affiliation(s)
- Nicole Rosendale
- Neurohospitalist Division, Department of Neurology, University of California San Francisco, 1001 Potrero Avenue, Building 1, Room 101, Box 0870, San Francisco, CA 94110, USA.
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25
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Suolang D, Chen BJ, Wang NY, Gottesman RF, Faigle R. Geographic and Regional Variability in Racial and Ethnic Disparities in Stroke Thrombolysis in the United States. Stroke 2021; 52:e782-e787. [PMID: 34670410 DOI: 10.1161/strokeaha.121.035220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis (IVT) after ischemic stroke is underutilized in racially/ethnically minoritized groups. We aimed to determine the regional and geographic variability in racial/ethnic IVT disparities in the United States. METHODS Acute ischemic stroke admissions between 2012 and 2018 were identified in the National Inpatient Sample. Multivariable logistic regression was used to test the association between IVT and race/ethnicity, stratified by geographic region and controlling for demographic, clinical, and hospital characteristics. RESULTS Of the 545 509 included cases, 47 031 (8.6%) received IVT. Racially/ethnically minoritized groups had significantly lower adjusted odds of IVT compared with White people in the South Atlantic region (odds ratio [OR], 0.86 [95% CI, 0.82-0.91]), the East North Central region (OR, 0.91 [95% CI, 0.85-0.97]) and the Pacific region (OR, 0.90 [95% CI, 0.85-0.96]). In the South Atlantic region, IVT use in racial/ethnic minority groups was below the national average of all racial/ethnic minority patients (P=0.002). Compared with White patients, Black patients had lower odds of IVT in the Middle Atlantic region (OR, 0.84 [95% CI, 0.78-0.91]), the South Atlantic region (OR, 0.78 [95% CI, 0.74-0.82]), and the East North Central region (OR, 0.86 [95% CI, 0.79-0.93]). In the South Atlantic region, this difference was below the national average for Black people (P<0.001). Hispanic patients had significantly lower use of IVT only in the Pacific region (OR, 0.92 [95% CI, 0.85-0.99]), while Asian/Pacific Islander patients had lower odds of IVT in the Mountain (OR, 0.76 [95% CI, 0.59-0.98]) and Pacific region (OR, 0.89 [95% CI, 0.82-0.97]). CONCLUSIONS Racial/ethnic disparities in IVT use in the United States vary by region. Geographic hotspots of lower IVT use in racially/ethnically minoritized groups are the South Atlantic region, driven predominantly by lower use of IVT in Black patients, and the East North Central and Pacific regions.
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Affiliation(s)
- Deji Suolang
- Departments of Neurology (D.S., B.J.C., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bridget J Chen
- Departments of Neurology (D.S., B.J.C., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nae-Yuh Wang
- Medicine (N.-Y.W.), Johns Hopkins University School of Medicine, Baltimore, MD.,Biostatistics (N.-Y.W.), Johns Hopkins University School of Medicine, Baltimore, MD.,Epidemiology (N.-Y.W.), Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Center for Health Equity, Baltimore, MD (N.-Y.W., R.F.)
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Intramural Research Program, National Institutes of Health, Bethesda, MD (R.F.G.)
| | - Roland Faigle
- Departments of Neurology (D.S., B.J.C., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD.,Johns Hopkins Center for Health Equity, Baltimore, MD (N.-Y.W., R.F.)
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26
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Mkoma GF, Johnsen SP, Iversen HK, Andersen G, Norredam M. Incidence of stroke, transient ischaemic attack and determinants of poststroke mortality among immigrants in Denmark, 2004‒2018: a population-based cohort study. BMJ Open 2021; 11:e049347. [PMID: 34675015 PMCID: PMC8532551 DOI: 10.1136/bmjopen-2021-049347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Using recent registry data, we aimed to quantify the incidence of stroke and transient ischaemic attack (TIA) and to examine factors influencing the risk of poststroke mortality among immigrants compared with Danish-born individuals. DESIGN Population-based cohort study between 2004 and 2018. We estimated age-standardised incidence rate ratios (IRR) of stroke, stroke types and TIA for each ethnic group using Danish-born individuals as the reference by direct method of standardisation. We calculated the risk of poststroke mortality using Cox proportional hazard regression. SETTING The study was conducted using Danish nationwide registers. PARTICIPANTS All cases of first-ever stroke and TIA by country of origin (n=132 936) were included. RESULTS Overall, Western immigrants (IRR=2.25; 95% CI 2.20 to 2.31) and non-Western immigrants (IRR=1.37; 95% CI 1.30 to 1.44) had a higher risk of stroke than Danish-born individuals. The risk of TIA was higher in Western immigrants (IRR=2.08; 95% CI 1.93 to 2.23) followed by non-Western immigrants (IRR=1.45; 95% CI 1.27 to 1.63) than in Danish-born individuals. All-cause 1-year mortality hazard was higher but not significantly different in non-Western men (adjusted HR=1.38; 95% CI 0.92 to 2.08) compared with Danish-born men and additional adjustment for comorbidities reduced the HR to 0.85 (0.51 to 1.40) among ischaemic stroke cases. Among intracerebral haemorrhage cases, the adjusted mortality hazard was decreased in Western men (from HR of 1.76; 95% CI 1.09 to 2.85 to HR of 1.30; 95% CI 0.80 to 2.11) compared with Danish-born men after adjustment for stroke severity. Immigrants with ≤15 years of residence had a lower poststroke mortality hazard than Danish-born individuals after additional adjustment for sociodemographic factors (HR=0.36; 95% CI 0.14 to 0.91). CONCLUSIONS The age-standardised risk of stroke and TIA was significantly higher among the majority of immigrants than Danish-born individuals. Interventions that reduce the burden of comorbidities, improve acute stroke care and target sociodemographic factors may address the higher risk of poststroke mortality among immigrants.
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Affiliation(s)
- George Frederick Mkoma
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Centre for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helle Klingenberg Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Grethe Andersen
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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27
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Shang J, He Y, Wang R, Xu Y, Xu J. Comparison of therapeutic effects of different acupuncture and moxibustion therapies on constipation after stroke treatment: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27397. [PMID: 34731111 PMCID: PMC8519190 DOI: 10.1097/md.0000000000027397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Constipation is a common complication after stroke, which seriously affects patients' quality of life and recovery. Many evidences show that acupuncture and moxibustion therapy has advantages in the treatment of constipation after stroke. But different types of acupuncture and moxibustion have different effects, and there is no research to prove which one is more effective. METHODS According to the search strategy, we will retrieve the randomized controlled studies of acupuncture and moxibustion in the treatment of constipation after stroke from China Knowledge Network, Wanfang, VIP, China Biomedical medicine, PubMed, Embase, Web of Science, and The Cochrane Library databases. The retrieval time was from the establishment of the database to July 2021. Studies will be screened according to inclusion and exclusion criteria, and the quality of the studies will be assessed using the Cochrane Risk Bias Assessment Tool. All data analyses will be performed using Revman 5.4, Gemtc 0.14.3, and Stata 14.0. Finally, we will evaluate the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS In this study, the efficacy of different acupuncture and moxibustion therapies in the treatment of constipation after stroke will be evaluated by evaluating defecation frequency, stool property score, constipation symptom score, quality of life score, adverse reactions, etc. CONCLUSIONS This study will provide reliable evidence-based evidence for selecting the best acupuncture and moxibustion therapy for constipation after stroke.
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Affiliation(s)
- Jingwen Shang
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Yongyang He
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Rui Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yifan Xu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Xu
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
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28
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Otite FO, Saini V, Sur NB, Patel S, Sharma R, Akano EO, Anikpezie N, Albright K, Schmidt E, Hoffman H, Gould G, Khandelwal P, Latorre JG, Malik AM, Sacco RL, Chaturvedi S. Ten-Year Trend in Age, Sex, and Racial Disparity in tPA (Alteplase) and Thrombectomy Use Following Stroke in the United States. Stroke 2021; 52:2562-2570. [PMID: 34078107 DOI: 10.1161/strokeaha.120.032132] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Fadar Oliver Otite
- Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse
| | - Vasu Saini
- University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)
| | | | - Smit Patel
- University of Connecticut, Hartford (S.P.)
| | | | - Emmanuel O Akano
- Molecular Neuropharmacology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD (E.O.A.)
| | - Nnabuchi Anikpezie
- Department of Healthcare Transformation Initiative, University of Texas Health Science Center at Houston (N.A.)
| | - Karen Albright
- Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse
| | - Elena Schmidt
- Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse
| | - Haydn Hoffman
- Department of Neurosurgery (H.H., G.G.), State University of New York (SUNY) Upstate Medical University, Syracuse
| | - Grahame Gould
- Department of Neurosurgery (H.H., G.G.), State University of New York (SUNY) Upstate Medical University, Syracuse
| | | | - Julius Gene Latorre
- Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse
| | - Amer M Malik
- University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)
| | - Ralph L Sacco
- University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)
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29
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2972] [Impact Index Per Article: 990.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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30
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Chen G, Bai C, Zhu Z, Li J, Shao S. Effectiveness and safety of different doses of tenecteplase in the treatment of acute ischemic stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23805. [PMID: 33545944 PMCID: PMC7837936 DOI: 10.1097/md.0000000000023805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Tenecteplase is a modified recombinant tissue-plasminogen activator, which is effective and safe in the treatment of acute ischemic stroke. However, the therapeutic dose of tenecteplase has been controversial. The purpose of this study is to systematically investigate the efficacy and safety of different doses of tenecteplase thrombolytic therapy for acute ischemic stroke. METHODS Computer retrieval of English databases (PubMed, EMBASE, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wanfang, Viper, and Chinese Biomedical Database) is conducted for a randomized controlled clinical study on thrombolytic treatment of acute ischemic stroke with different doses of tenecteplase from the establishment of the database to October 2020. Two researchers independently conduct data extraction and literature quality evaluation on the quality of the included studies, and meta-analysis is conducted on the included literatures using RevMan5.3 software. OUTCOME In this study, National Institute of Health Stroke Scale (NIHSS) score, Modified Rankin Scale (mRS) score scale, symptomatic intracranial hemorrhage (SICH) incidence, All-cause mortality, and so on are used to evaluate the efficacy and safety of tenecteplase thrombolytic therapy in acute ischemic stroke with different doses. CONCLUSION This study will provide reliable evidence-based evidence for the clinical application of different doses of tenecteplase in thrombolytic therapy for acute ischemic stroke. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/2MPCW.
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Chen Q, Li L, Xie H. [Research progress of different types of stem cells in treatment of ischemic stroke]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:111-117. [PMID: 33448208 DOI: 10.7507/1002-1892.202004160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the recent research progress of different types of stem cells in the treatment of ischemic stroke. Methods By searching the PubMed database, a systematic review had been carried out for the results of applying different types of stem cells in the treatment of ischemic stroke between 2000 and 2020. Results Stem cells can be transplanted via intracranial, intravascular, cerebrospinal fluid, and intranasal route in the treatment of ischemic stroke. Paracrine and cell replacement are the two major mechanisms of the therapy. The researches have mainly focused on utilization of neural stem cells, embryonic stem cells, and mesenchymal stem cells. Each has its own advantages and disadvantages in terms of capability of migration, survival rate, and safety. Certain stem cell therapies have completed phase one clinical trial. Conclusion Stem cells transplantation is feasible and has a great potential for the treatment of ischemic stroke, albeit that certain obstacles, including the selection of stem cells, transplantation strategy, migration ability, survival rate, still wait to be solved.
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Affiliation(s)
- Qiuzhu Chen
- Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ling Li
- Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Vyas MV, Laupacis A, Austin PC, Fang J, Silver FL, Kapral MK. Association Between Immigration Status and Acute Stroke Care. Stroke 2020; 51:1555-1562. [DOI: 10.1161/strokeaha.119.027791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Immigrants to high-income countries have a lower incidence of stroke compared with long-term residents; however, little is known about the care and outcomes of stroke in immigrants.
Methods—
We used linked clinical and administrative data to conduct a retrospective cohort study of adults seen in the emergency department or hospitalized with ischemic stroke or transient ischemic attack between July 1, 2003, and April 1, 2013, and included in the provincial stroke registry. We ascertained immigration status using immigration records and compared processes of stroke care delivery between immigrants (defined as those immigrating after 1985) and long-term residents. In the subgroup with ischemic stroke, we calculated inverse probability treatment weight (IPTW)–adjusted risk ratios for disability on discharge (modified Rankin Scale score of 3 to 5), accounting for demographic characteristics and comorbid conditions to compare outcomes between immigrants and long-term residents.
Results—
We included 34 987 patients with ischemic stroke or transient ischemic attack, of whom 2649 (7.6%) were immigrants. Immigrants were younger than long-term residents at the time of stroke/transient ischemic attack (median age 67 years versus 76 years;
P
<0.001). In the subgroup with ischemic stroke, there were no differences in stroke care delivery, except that a higher proportion of immigrants received thrombolysis than long-term residents (21.2% versus 15.5%;
P
<0.001). Immigrants with ischemic stroke had a higher adjusted risk of being disabled on discharge (adjusted risk ratio, 1.18; 95% CI, 1.13–1.22) compared to long-term residents.
Conclusions—
Stroke care is similar in Canadian immigrants and long-term residents. Future research is needed to confirm the observed association between immigration status and disability after stroke and to identify factors underlying the association.
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Affiliation(s)
- Manav V. Vyas
- From the Division of Neurology, Department of Medicine (M.V.V., F.L.S.), University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation (M.V.V., A.L., P.C.A., M.K.K.), University of Toronto, Canada
| | - Andreas Laupacis
- Institute of Health Policy, Management and Evaluation (M.V.V., A.L., P.C.A., M.K.K.), University of Toronto, Canada
- Division of General Internal Medicine, Department of Medicine (A.L., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (A.L., P.C.A., J.F., F.L.S., M.K.K.)
| | - Peter C. Austin
- Institute of Health Policy, Management and Evaluation (M.V.V., A.L., P.C.A., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (A.L., P.C.A., J.F., F.L.S., M.K.K.)
| | - Jiming Fang
- ICES, Toronto, Canada (A.L., P.C.A., J.F., F.L.S., M.K.K.)
| | - Frank L. Silver
- From the Division of Neurology, Department of Medicine (M.V.V., F.L.S.), University of Toronto, Canada
- ICES, Toronto, Canada (A.L., P.C.A., J.F., F.L.S., M.K.K.)
| | - Moira K. Kapral
- Institute of Health Policy, Management and Evaluation (M.V.V., A.L., P.C.A., M.K.K.), University of Toronto, Canada
- Division of General Internal Medicine, Department of Medicine (A.L., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (A.L., P.C.A., J.F., F.L.S., M.K.K.)
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Yang W, Yang J, Xiong X, Weng X, Wu W. Effect of Statins on Patients with Acute Ischemic Stroke Infection based on Intelligent Data Acquisition of Computed Tomography Image information (Preprint). JMIR Med Inform 2020. [DOI: 10.2196/18571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4715] [Impact Index Per Article: 1178.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Garg R, Rech MA, Schneck M. Stroke Mimics: An Important Source of Bias in Acute Ischemic Stroke Research. J Stroke Cerebrovasc Dis 2019; 28:2475-2480. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/05/2019] [Accepted: 06/15/2019] [Indexed: 01/22/2023] Open
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Yang S, Wang H, Yang Y, Wang R, Wang Y, Wu C, Du G. Baicalein administered in the subacute phase ameliorates ischemia-reperfusion-induced brain injury by reducing neuroinflammation and neuronal damage. Biomed Pharmacother 2019; 117:109102. [PMID: 31228802 DOI: 10.1016/j.biopha.2019.109102] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/24/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023] Open
Abstract
Ischemic stroke is a cerebrovascular disease with high morbidity, high mortality, and high disability, representing a serious threat to human life and health. Clinically, the extensive injury caused by ischemic stroke results from ischemia-reperfusion (I/R) injury thrombolytic treatment. However, there are few reports on the use of medications in the subacute stage of cerebral I/R. Baicalein (5,6,7-trihydroxyflavone) is a biologically active ingredient extracted from the root of Scutellaria baicalensis Georgi. In the present study, we investigated the therapeutic effect of baicalein administered in the subacute phase of cerebral I/R injury in a rat model of ischemia induced by occlusion of the middle cerebral artery (MCA). Rats were treated daily with baicalein (200 mg/kg, i.g.) in the subacute phase (24 h after reperfusion) for 7 days. The results showed that baicalein significantly reduced neurobehavioral deficits and decreased brain infarct volume from 18.99% to 7.41%. Immunofluorescence analysis of the ischemic penumbra showed that baicalein significantly reduced expression of the M1 marker, cluster of differentiation (CD) 16 and CD86, and increased expression of the M2 marker, CD 163 and CD206, indicating that baicalein inhibited M1 transformation and promoted M2 transformation of microglia/macrophage to inhibit neuroinflammation. Moreover, baicalein suppressed NF-κB signaling by reducing IκBα phosphorylation and nuclear translocation of NF-κB/p65, which decreased the release of the pro-inflammatory factors IL-6, IL-18, and TNF-α. In addition, baicalein reduced phosphorylation of JNK, ERK and p38, which are involved modulation of microglia/macrophage M1/M2 polarization. Western blot analysis of apoptosis- and autophagy-related proteins showed that baicalein increased the Bcl-2/Bax ratio and reduced caspase-3 expression to decrease neuronal apoptosis and ameliorate neuronal loss. Baicalein also decreased the LC3-II/LC3-I ratio and promoted phosphorylation of the PI3K/Akt/mTOR signaling pathway which implied inhibition of autophagy. These observations suggest that baicalein exerts neuroprotective effects by reducing neuroinflammation, apoptosis and autophagy, and protects against cerebral I/R injury in the subacute phase in vivo.
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Affiliation(s)
- Shilun Yang
- School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.2 Nanwei Road, Beijing, 100050, China
| | - Haigang Wang
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.2 Nanwei Road, Beijing, 100050, China
| | - Yinglin Yang
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.2 Nanwei Road, Beijing, 100050, China
| | - Rui Wang
- School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, No.280, Waihuan East Road, Guangzhou, 510006, China
| | - Yuehua Wang
- Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.2 Nanwei Road, Beijing, 100050, China
| | - Chunfu Wu
- School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, China.
| | - Guanhua Du
- School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang, 110016, China; Beijing Key Laboratory of Drug Targets Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.2 Nanwei Road, Beijing, 100050, China.
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